SWHAP - 14 Years of Championing in Sub Saharan Africa - HIV and Wellness Programmes
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SWHAP – 14 Years of Championing HIV and Wellness Programmes in Sub Saharan Africa 14 Investing in Workplace HIV and Wellness Programmes: Good for Companies, Good for Employees, Good for Families and for Communities
A publication by the Swedish Workplace HIV and AIDS Programme (SWHAP) www.swhap.org Indexing terms: HIV/AIDS Workplace Programme Africa ISBN: 978-91-86507-36-7 (print) 978-91-86507-37-4 (electronic) © Swedish Workplace HIV and AIDS Programme (SWHAP) Published with financial support from the Swedish International Development Cooperation Agency (Sida). The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the financiers.
Contents Introduction .................................................................4 Support for the Sustainable Development Goals ..................7 SWHAP Programme Overview ..............................8 The SWHAP Model .................................................................................... 8 SWHAP Impact ..........................................................................................10 Key Success Factors ................................................................................12 SWHAP Networks ...................................................................................... 14 Capacity Building ...................................................................................... 14 Supply Chain and Mentorship Models ........................................ 14 Promotion of Gender Sensitive Workplaces and Communities ............................................................................................... 15 Good for Companies .............................................. 16 Why invest in wellness - Snapshot Business Case and .......... Reputational Gains ..................................................................................16 Good for Employees ............................................... 22 Unions and their Contribution to Successful Workplace Programmes.............................................................................................................. 24 Good for Families .................................................... 32 Good for Communities .......................................... 35 A Huge Thank You! .................................................. 41 3
Introduction Globally, 36.9 million people were living with HIV at the end of 2017 (WHO); approximately two thirds of them were in sub-Saharan Africa, making addressing HIV and AIDS a key priority for the region. Because HIV affects people in the It is estimated most economically productive period of that the medical their lives it results in reduced earnings expenses and lost and higher spending on medical costs productivity cost of ill workers account with a knock-on effect on savings and for 10-15% of global disposable income. In addition to human economic output. suffering, HIV has the potential to cripple Global Wellness the working population, increasing Institute company costs and reducing output. The impact of the HIV epidemic is aggravated by a worldwide trend towards urbanisation and unhealthy lifestyles that have led to an explosion of non-communicable diseases (NCDs), which the World Health Organization projects will cost over US$30 trillion in the next 20 years, threatening productivity as well as national development and economic growth. To protect their bottom line, and the long-term welfare of their employees, companies need to actively engage in risk management since the average full-time worker spends a third of their day at work. As such, the workplace has both the capacity and the opportunity to influence the physical, mental, economic and social wellbeing of employees and, in turn, the health of their families and 4 communities – it is an ideal arena for promoting health.
For over fourteen years, the Swedish Workplace HIV and AIDS Programme (SWHAP) has demonstrated the effectiveness of public- private partnerships in improving wellness and productivity in the workplace. SWHAP provides catalytic support to companies to develop and implement workplace HIV and wellness programmes that address employees’ health needs, based on close partnership and cooperation between management, employees and trade unions – resulting in healthier employees and more productive companies. This booklet shares a few of the many examples on how wellness programmes using the SWHAP approach reduce HIV impact, while improving productivity and employee satisfaction and loyalty. 14 years of SWHAP has resulted in: ll Healthier workplaces and increased productivity. ll Development of diverse, inclusive and gender sensitive workplaces reducing employee turnover and positively impacting unemployment and skills development. ll Establishment of a better dialogue climate at the workplace, reducing stigma and conflict – influencing and improving the general work environment. ll Protection of the human rights of workers through implementation of anti-discrimination policies and information and awareness raising, on these and other related policies. ll Highlighting of sustainability as a core operational condition for companies and employees. ll Improved understanding of sexual reproductive health and rights (SRHR) and enhanced access to SRHR services. ll Creation of networks connecting companies from diverse countries and sectors for peer to peer exchanges on workplace disease management and sustainability strategies. The networks have made SWHAP an attractive partner for private sector engagement on HIV. Consequently, SWHAP contributes to national response frameworks in various countries. ll Contribution to social dialogue at national level between unions and employer associations. 5
Support for the Sustainable Development Goals SWHAP also exemplifies a responsible private sector contributing to sustainable development, as workplace wellness programmes: ll Contribute to good health and employee wellbeing. Health programmes also extend to families, communities, and the value chain of companies providing information, testing opportunities and access to healthcare. ll Mainstream gender into policies and regulations at the workplace and ensure that gender is a consideration and application in all business decisions, management, operations and sustainability strategies. ll Increase productivity and business efficiency essential for economic growth and more job opportunities. Programmes are also run through representative committees consisting of management, workers and unions using social dialogue to address relevant issues and protect interests and rights of all parties. ll Offer public-private partnership with scalable catalytic financial support to establish the programmes and decrease risks. Partnerships are established to lower costs, increase reach and spread the impact of the programmes. Through networks and peer-to-peer exchanges companies can collectively share experiences and address common challenges. 7
SWHAP Programme Overview SWHAP is a public private partnership established by the International Council of Swedish Industry, NIR, and the Industrial and Metal Workers’ Union of Sweden, IF Metall, and co-financed by Sida. It is a long-term strategy to contribute to the establishment and/or support of HIV and wellness management programmes in workplaces across sub-Saharan Africa. SWHAP aims to benefit companies, employees and their families, as well as the wider community. This helps ensure the sustainability of wellness programmes and improves community wellness. At the time of inception, in 2004, there were very few examples of public- private partnerships addressing HIV and AIDS in the SWHAP PARTNERS workplace and the objective of the programme was REDUCE HIV to bring those affected together to share experiences Research from SWHAP South and ideas on overcoming the business challenges Africa showed that: created by the AIDS pandemic. ll HIV prevalence dropped by 0.7% between 2012 and The SWHAP Model 2016 The SWHAP model is a partnership model that uses ll Very few employees social dialogue as a method where management and who previously tested workers’ representatives together take responsibility negative later tested for the design and implementation of the workplace positive programme. This increases ownership at company ll Most HIV positive level providing motivation for further investments into workers were workplace wellness. productively SWHAP has identified eight common steps in the employed and implementation of programmes that most companies enrolled on employee go through. This is, however, not prescriptive, as support programmes. support is tailored to recognise the different contexts and challenges faced by the companies. 8
The SWHAP Model Management and Peer Educator employee ownership Programme and partnership Employee Assistance Programme Family and Share, coach community and mentor outreach SWHAP provides: ll Technical support. ll Networking platforms for companies and partners to share experiences and materials. ll Templates, tools and case studies that help partners with workplace wellness management. ll Financial and technical support for supply chain programmes that contribute to a healthier business chain. ll Mentorship programmes for unions and employers’ organisations that build their capacity to respond to members’ wellness needs. SWHAP Support Financial and technical support to workplace programmes Supply Chain and mentoring programmes 9
Programme Sphere of Influence Over Three Year Period Year 1& 2 - Family Involvement of families in wellness days Spousal programmes Community Family Year 3 -Community Interventions for value chain, neighbouring communities & key Workplace populations Year 1 -Workplace Establishment of baselines Capacity building Set up of programme structures SWHAP Impact Since 2004, when the Programme was launched in 10 companies in South Africa, SWHAP has grown annually both in terms of the number of workplaces supported and the countries with SWHAP presence. In 2017, over 500 workplaces from 11 countries benefitted from participation in the programme. According to testimonies from the companies, the programme has led to changes in culture at the workplace, including reduced stigma and behaviour change. 10
SWHAP in 2017 An Economic Evaluation of the SWHAP South Africa programme by Karolinska Institutet in 2018, produced the following results: ll A return on investment analysis showed that among 1,000 employees and at an annual cost of ZAR 300,000, an average of 20.84 HIV infections per year will be averted: 7.27 among employees and 13.57 among their sexual partners. ll A net benefit analysis shows that funds invested in the programme, result in absolute cost-savings of ZAR 134.42 per employee. ll The estimated benefit cost ratio suggests that for every Rand spent, the employer can expect to benefit by ZAR 1.45: a 44.8% return on investment. 11
Key Success Factors This section details some of the most important elements of SWHAP’s success. Partnerships The emphasis on partnership between unions, employees and management is a critical aspect of the programme. It results in more effective workplace programmes with greater buy-in at all levels of the workplace, which contributes to improved dialogue and strengthened industrial relations both within companies and in society in general. In 2017, partnership with unions resulted in an additional 74 workplaces establishing HIV and wellness programmes. Cost-Sharing Model The workplace programmes are financed by the companies and by Sida through a co-funding mechanism, where the companies pay 40- 60% on a sliding scale over three years. This means after three years, the companies finance the majority of the programme. This co-financing mechanism has reduced the risks professed by managers about the perceived costs of workplace programmes and creates a strong element of sustainability. In fact, only one company out of 166 has left the programme. = 10% SWHAP (Sida) = 90% Private Sector 99% of company programmes continue after co-financing Company investments in workplace programmes SWHAP programme catalytic investment. 12
A Rights-Based Approach Programmes are based on mandatory HIV and wellness policies that ensure the confidentiality of employees’ HIV status, protect against discrimination, and promote gender equality. Workplaces report that prior to programme implementation, many workers did not want to test, fearing that a positive result would risk their employment. The right to confidentiality is now well respected amongst companies and has also promoted trust between management and employees. Summary Impact 150 Number of Companies 100 50 0 Policy Training VCT Staff have implemented programme provided access to ARV in place Before SWHAP 2004 Implemented through SWHAP by 2015 (including supply chain and mentorship companies) A Wellness Approach SWHAP encourages wellness management, which is a broad approach to dealing with HIV and is shown to reduce stigma, encourage trust, and lead to more effective workplace programmes. Companies have Communicable diseases demonstrated that wellness Financial NCDs Management tests that include HIV testing and counselling (HCT), increase uptake by de-stigmatising testing. Additionally, Stress SRHR & gender management wellness management addresses Wellness Management related diseases, lifestyle, and societal issues that can either contribute to the spread of HIV or affect those Tuberculosis living with HIV disproportionately. HIV/AIDS Malaria 13
SWHAP Networks SWHAP uses networking as a relatively low cost means to maintain programme momentum within different key groups in the workplace programme, for example; CEOs, Peer Educators and Steering Committees. Networks: SWHAP NETWORKS ll Sensitise CEOs and senior level managers on the business case for workplace wellness, seeding sustainability. Number of network 211 sessions held in 10 ll Support cost sharing activities and build countries since 2014 capacity in programme planning, budgeting, implementation, monitoring and evaluation. ll Allow sharing of experiences that promote % of participants who replication of programme successes. rated networks 80% as useful in 2017 ll Provide technical support to companies and communities to better respond to the often- rapid changes in the epidemic. Capacity Building Key to the sustainability of the workplace programme is company ownership. In order to support ownership, SWHAP provides internal capacity building for management representatives, Peer Educators and Steering Committee members. In 2017, out of the 1,129 active Peer Educators, 74% enhanced their knowledge on SRHR, programme implementation strategies, gender norms transformation, and NCDs through network meetings and training workshops. Such training reduces over reliance on external facilitators to run programmes and supports external mainstreaming of programmes at community level. Supply Chain and Mentorship Models Companies that have set up HIV and wellness programmes are encouraged to share their experiences with their value chain through SWHAP Supply Chain or Mentorship Programmes. These encourage the sharing of HIV and wellness knowledge, skills, and experiences through the principles of mentorship, participatory 14
learning, networking and on-going support. Mentor companies take the lead in implementing the programme. They are responsible for coordination, logistics, monitoring and evaluation, and liaison with service providers to support training and testing for HIV, and other medical conditions. SWHAP has found this strategy a cost-effective way to reach multiple workplaces. In 2017, 175 workplaces were supported to reach more than 16,000 workers with HIV and AIDS information, develop policies, build capacity amongst Peer Educators and steering committee members, and to conduct HCT. Promotion of Gender Sensitive Workplaces and Communities Gender inequality and harmful gender norms are associated with the spread of HIV and its consequences – making integrating gender into HIV and AIDS responses essential. SWHAP promotes gender equity in workplaces and communities using three approaches: gender mainstreaming and diversity management; targeted gender activities (addressing specific issues related to gender); and gender-aware dialogues. These initiatives are helping to ensure that both men and women access comprehensive HIV prevention treatment, care and support services. At male dominated workplaces, the involvement of spouses and families through spouse peer education programmes, wellness days, couples testing and training on SRHR is transforming gender relationships and promoting gender equity at both workplace and community level. 15
Good for Companies If you could say one thing to business leaders about workplace programmes, what would that be? “This [workplace programme] is not a welfare issue, it is a business issue. Healthy employees produce at their best. People want two things; health and wealth. Help them take care of their health, and wealth will come to both parties. If your employees are not healthy you are losing on your bottom line”. Divine Ndhlukula, Managing Director, Securico Security Services, Zimbabwe Why invest in wellness – Snapshot Business Case and Reputational Gains Wellness – the Business Case HIV and AIDS may cost companies between 2% and 6% of salaries per year in direct costs for healthcare and other employee benefits, and indirect costs for absenteeism (illness and funerals), lost skills, training and recruitment costs, reduced work performance and lower productivity. In South Africa, the estimated cost of lost productivity due to depression is US$17 BILLION – of which US$14 BILLION is down to presenteeism1. IN CONTRAST HIV programmes reduce risk and pension fund contributions, far outstripping the cost of the HIV programme itself. Wellness programmes are associated with a 14% increase in employee satisfaction & reduced staff turnover2 Employees with higher levels of wellbeing are up to 3 X MORE PRODUCTIVE than their less healthy colleagues3 1 Evans- Lacko, S. & Knapp, M. Soc Psychiatry Psychiatric Epidemiology (2016) 51: 1525 2 Union for International Cancer Control, Cancer it’s Everyone’s Business 3 World Economic Forum (2010b), The Wellness Imperative - Creating More Effective Organizations 16
Value for Companies Employee wellness programmes: ll Improve recruitment and retention of skilled staff, reducing staff turnover. ll Reduce absenteeism and the negative effects of presenteeism. ll Improve workplace productivity. ll Improve job satisfaction and employee morale. ll Foster organisational commitment. Unacknowledged ill health among employees, presenteeism (where the employee is present at work but not able to fully contribute) and increased sick days can be major contributors to lost productivity. Additionally, there are knock- on effects on medical, pension and life insurance contribution costs. A sustainable wellness programme can create a positive impact on society and the environment, which in turn, positively affects the company’s financial bottom line and generates shared value. 17
Increasing Pension Fund Contributions with HIV Workplace Programmes – Atlas Copco South Africa Atlas Copco created its HIV and AIDS workplace programme in 2002. By the following year, the basics of the Programme were in place and the company offered its first HIV counselling and testing activity. The first person to get tested for HIV was the then CEO. This gave confidence for everyone else at the company to test, and as a result, 96% of employees got to know their HIV status. Since then, Atlas Copco has established a successful and sustainable programme built on the involvement of both workers and management in creating the trust needed around the programme. Achievements: ll The impressive results of the programme convinced Atlas Copco’s death and disability insurance provider to lower its premiums. These savings of ZAR 1 million have been invested in increased pension fund contributions, benefitting all employees and creating a powerful incentive for continuous engagement in the HIV workplace programme. ll Other less tangible benefits are reduced sick leave and lower staff turnover (due to fewer deaths), which lower recruitment and training costs. “Collaboration with the SWHAP Network has not only resulted in a more creative and sustainable programme but given the Company the impetus to challenge service providers to provide better data, benefits and savings to our staff.” Wendy Buffa-Pace, Corporate Human Resources & Communications Manager, Atlas Copco 18
Savings on Group Life Cover and Pension Premiums Equal the Cost of the Programme – Ericom Communications Zimbabwe Since 2007, Ericom Communications have only lost one worker to an AIDS-related death. This is in sharp contrast to 2000, prior to the implementation of their workplace HIV and wellness programme, when in one year the company lost five experienced technicians from the same department. Achievements: ll As a result of a well-functioning HIV programme and high HCT-uptake, Ericom Communications Zimbabwe’s Group Life Cover and Pensions Fund Administrator reduced contributions for current active members from 4.2% (USD 1,703) to 2.2% (USD 892), saving Ericom close to USD 10,000 per year – greater than the cost of the HIV programme. ll Following social dialogues, company management also identified gaps in gender and diversity and instituted in-house drama sessions, which created safe spaces to address a wide range of health-related issues including the relationship between gender and HIV. “Workplace HIV and AIDS Programmes work. I have seen the evidence of this at Ericom.” Tellmore Chiramba, Peer Educator, Ericom Communications 19
Inspired to do More to Manage Wellness in a Complex Environment – Sodeico Manpower, DRC When SWHAP was launched in the DRC in 2012, Sodeico, a specialist human resources firm was one of the first companies to join the programme. They had 2,000 agents placed in 46 companies, operating in 77 locations, in all 11 DRC provinces. Agents came from varied social environments and did not have the same access to information on HIV. Before the partnership with SWHAP, there were several positive cases amongst agents, staff or their family members, of which the company was unaware; at times, it was only on the death of an agent that they would find out that he or she had died of an AIDS-related illness. Achievements: ll 18 Peer Educators were trained and were instrumental in breaking down the taboo surrounding HIV. As a result, Sodeico achieved an HCT uptake of 86% on their first screening. ll A disease management programme was established giving free access to counselling, treatment, care, and follow up services for employees and their families. ll A women’s wellness day was held for more than 200 female agents where HIV, reproductive health, and family planning were discussed. 20
ll The programme benefitted staff at all levels. Former CEO of Sodeico, Mbanzi Moupondo, tested positive for high blood sugar at the 2015 SWHAP conference. He was later diagnosed with diabetes and put on treatment; through a radical change in lifestyle and the support of his staff, he overcame the disease. ll Sodeico is now in the process of diversifying its business and is investing in a clinic for both employees and people from the surrounding community. The investment will reduce Sodeico’ s healthcare costs by 50% – notable savings given healthcare costs in the country. “We learnt from SWHAP to see wellness and workplace programmes as a cost reduction strategy. I personally believe that without SWHAP, we would not have started looking at healthcare – the potential benefits, both, socially and economically.” Djo Moupondo, CEO, Sodeico Development 21
Good for Employees Getting to Zero using a wellness approach In 2015, Ericsson Uganda noted a decline in the number of employees participating in HTC, so the company extended their HIV programme to include wellness, allowing employees to check their body mass index, as well as test for diabetes and high blood pressure. Access to results was made available immediately after testing. Health risk profiling revealed that 20% of employees were overweight to obese, leading the company to implement targeted interventions including promoting nutrition, physical activity and stress management in conjunction with the existing chronic disease management programme. The company also collaborated with the Uganda Cancer Institute to raise awareness and provide cervical and prostate cancer screening for employees. At the wellness day following these initiatives, 91 members of staff participated in health screening and 88 were tested for HIV. Employee Benefits Ericsson noted the following benefits to employees: ll Convenient worksite screening and support ll Support in weight management ll Improved physical fitness and stamina ll Lower levels of stress ll Increased well-being, self-image and self-esteem ll Reduced healthcare costs. 22
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Unions and their contribution to successful workplace programmes Unions are an important partner in ensuring engaged employees and the success of any wellness programme. An Employer/ Union Partnership in Kenya In Kenya, the transport sector accounts for more than 30% of GDP. Long distance truck drivers and their assistants, loaders, are an integral part of the sector and their health affects its profitability. However, their health needs are not always adequately met. In some areas, HIV prevalence for truckers is between 25% and 32%, which is, in many cases, more than double the national averages (kmcc.org.ug). In response to its members’ needs, The Kenya Long Distance Truck Drivers and Allied Workers Union (KLDTAWU) began offering roadside testing at sites along the Northern Corridor. While roadside testing provided convenient access to HIV and wellness services for the truckers, it failed to address the structural issues that were making them more vulnerable to HIV, sexually transmitted infections (STIs) and other health issues. A partnership with SWHAP, the International Labour Organization and the Federation of Kenya Employers (FKE), catalysed dialogue and networking between the union and employers, resulting in the expansion of the programme. Achievements: ll Comprehensive HIV workplace programmes were developed for 30 companies; 3000 employees tested for HIV and 6,090 people were reached with health information. ll Policy development and standardisation of policies in line with ILO Recommendation No.200 of 2010, for 30 companies, ensuring a supportive environment for HIV positive workers and prevention interventions for those who were negative. ll HIV and AIDS management capacity built within SMES. Over 100 management representatives were also sensitised on the business benefits of workplace HIV and wellness programmes. 24
ll Companies involved in the programme from Nairobi were incorporated into the FKE Human Resource Network Forum, helping management to keep abreast with developments relating to the management of HIV in the workplace and other industrial relations issues. ll The HIV and AIDS policy development process provided an entry point to engage transport companies on labour laws (for example on sexual harassment), contributing to the overall decent work agenda. ll The mentorship programme created forums for discussions on how unions and employer organisations can work together to address other industrial relations issues beyond Kenya’s borders – the Secretary General of KLDTDAWU is Chair of a regional truck driver’s association. Unions are also taking up issues at national level to ensure legal and policy changes. “We can contribute to changing the attitudes of the employers and our membership to a common understanding of the realities. HIV does not discriminate; it affects employees and management alike.” George Kalumbi Sikazwe, Director of Research, NUBEGW The Zambia National Union of Building and Engineering and General Workers (NUBEGW), with a membership of 11,805, including Atlas Copco and Sandvik employees, has trained advocates to get HIV and AIDS clauses included in collective bargaining agreements. The Union has also drafted an HIV and AIDS policy for the sector. In Zimbabwe, the National Engineering Workers Union (NEWU) has been engaged in training sessions on the legal framework for HIV and the development of workplace wellness programmes – building capacity in 103 members from two provinces. The training is part of a national sector policy dissemination strategy. 25
In 2016, SWHAP and the ILO supported a partnership between NEWU, the Engineering Iron and Steel Association of Zimbabwe (EISAZ) and the Ministry of Public Service, Labour and Social Welfare for the development of a sector policy. The policy set out a framework for the prevention and management of HIV, AIDS, tuberculosis and other opportunistic infections for workers and their dependants. Workshops facilitated through these partnerships gave employers a clearer picture of how HIV impacts business, correcting previous beliefs that affected employees were careless – beliefs that fuelled discrimination in the workplace. SWHAP is also collaborating with the National Union of Metal and Allied Industries in Zimbabwe (NUMAIZ) to sensitise the Union’s focal persons on HIV and AIDS. NUMAIZ, an affiliate of the Zimbabwe Congress of Trade Unions (ZCTU), has around 9 000 members in five sectors. The majority of the DRC’s socio-economic activities take place in the informal sector and an estimated “80% of the active population operates outside the labour market” (afdb.org). Partnership with SWHAP has helped La Confédération Syndicale du Congo, or CSC, have a positive impact on the informal sector in the DRC, where the union is working to promote social protection and decent work. Prior to the mentorship with SWHAP, the union conducted ad hoc activities on HIV and AIDS for its members. The training assisted CSC to formally integrate HIV under the union’s social protection objectives, enhancing its capacity to teach employees and members how to protect themselves against HIV and other communicable and non-communicable diseases. Through various associations that are members of CSC, over 800 taxi drivers, female market vendors, mechanics and those working in agriculture, were reached with information on HIV prevention and family planning. Within the formal sector, the union created structures in 29 member companies to improve health interventions and outreaches that were already being conducted. Steering committees and vibrant peer education programmes are now promoting positive behaviour change in workplaces and communities. 26
Mainstreaming Gender and Diversity Management – An example from NUMSA Gender mainstreaming allows workplaces to better plan and respond to issues of gender and diversity, maximising the ability of all employees to contribute to organisational goals. In 2015, SWHAP piloted a programme to assist its partners with a more consistent approach to gender mainstreaming of their HIV and wellness programmes that is also integrated within other core areas of business. The Gender Coordinators from the National Union of Metal Workers of South Africa (NUMSA) were part of the programme. The SWHAP partnership with NUMSA built capacity amongst the Gender Coordinators to: organise social dialogues; raise awareness on HIV and workplace programmes and benefits; develop an understanding of gender and diversity management; and raise awareness on the options for mainstreaming gender for business sustainability. Olga Medupe, NUMSA Regional Gender Coordinator, explains how she and the other gender coordinators put those skills to use. 27
There was a transgender steward at one of the companies we work with. Stigma was rife and many of his colleagues did not want him in that role. Additionally, his management was not supportive. After attending the SWHAP gender and diversity mainstreaming training, we organised a workshop at the company to discuss the importance of diversity within the workplace and to promote dialogue. This resulted in reduction in stigma. The shop steward reported back to us saying that his work environment had improved and that colleagues were more understanding and treated him better. He was later promoted. In another workplace we had a female employee (only female employee in male dominated environment) who was forced to share the only changing room with male colleagues. She was at breaking point about to leave the company when through dialogue with the employers we persuaded them to set up a change room for women. The mainstreaming training gave us the skills to run workshops for her male colleagues and management at the company. “The training has given me the confidence to articulate issues and skills to promote dialogue.” Benefits of gender mainstreaming ll A gender diverse workforce provides easier access to resources, such as various sources of credit, multiple sources of information, and wider industry knowledge. ll A gender diverse workforce allows the company to serve an increasingly diverse customer base. ll Gender diversity helps companies attract and retain talented women. ll Addressing gender inequalities removes barriers to accessing HIV services, enabling women and men to access comprehensive HIV prevention, treatment, care and support services. 28
Peer Educators in the Workplace Peer Educators are a mainstay of HIV prevention in many developing countries and are supported to promote health-enhancing change among their peers and community by sharing health information, values and behaviour. For SWHAP, Peer Educators are an important link between management and employees and encourage employee trust and buy- in to wellness programmes. Peer Educators also encourage openness about the risks of HIV transmission within long-term relationships. Value for Peer Educators ll Peer Education training has an enduring effect that goes beyond the workplace. Learning transcends the workplace and benefits friends and family. ll Some Peer Educators leverage the experience to make career advancements. ll Peer Educators become an asset to the company as they apply their new competencies within the company. 29
Raising Awareness Among Spouses - Sympathy Chikukwa, Scanlink, Zimbabwe Scanlink is a male dominated workplace, and Ms Sympathy Chikukwa is the only female auto electrician. When she became a Peer Educator she realised that a lot of women were left out of the workplace programme. Working with other Peer Educators, she began to organise spousal trainings, where the wives of Scanlink employees were invited and subsequently learned about HIV, prevention, treatment and wellness. After speaking to the women at these events, Sympathy and her fellow Peer Educators realised that a lot of their information had not been reaching women previously. At the HIV, Counselling and Testing following the spousal training, uptake increased. By talking to the spouses of employees, Sympathy and her co-Peer Educators raise awareness as well as empower women with the knowledge and tools to talk to their husbands about the previously unthinkable topics of sex and sexuality. Sympathy illustrates this with an anecdote of a time that she told the wife of one of the employees whom she was teaching how to use a condom. She was surprised, saying, “Look, what are you teaching him? So you’re teaching him to be loose?” Sympathy recalls. She then explained to the wife that condoms are one of the tools against the spread of HIV and that there is nothing wrong with talking about sex and sexuality, I said: “Look, you might not want to talk with him about it, but I talk to him about it every day” and she realised that if her husband talks about it with another woman at work then she can also do it. Peer Educator Impact in the Workplace - Babcock Ntuthuko Babcock Ntuthuko Fabrication, in Jet Park, South Africa, has a culturally diverse work force of 65. Between them, the employees speak five different languages with varying levels of literacy. Diverse cultural and religious beliefs as well as language barriers affected information dissemination and employee engagement in the workplace wellness programme. The peer education team, led by Eugene Penny, responded to these challenges by organising an inclusive wellness week that increased employee engagement. The wellness programme improved employee willingness to approach Peer Educators with health-related queries. 30
Achievements: ll All employees have access to regular HIV and biometric screening, disease management and support services, along with HIV and wellness education and testing. ll Employees were educated on the dangers of smoking and drinking, promoting self-awareness and appreciation of their health and financial implications. ll Employee access to nutritional information and healthy eating was improved at minimal cost through competitions encouraging the creation and sharing of healthy recipes. ll Promotion of dialogue in the workplace contributed to improved interaction across the culture, language and economic divide. The dialogue also started addressing some of the negative cultural practices that hinder health seeking behaviours. ll The programme was recognised as a positive contribution to the company staff retention initiative. “At normal workplaces, time is not given to focus on employee health in a practical manner: you come in to work. This was different in- depth information. Everything came together during the wellness week. Employees recognised that handwashing, TB, HIV and nutrition are all interlinked. We understood the importance of good health for our ability to work, and that it prevents absenteeism. Otto’s [cancer survivor] testimony was really important for the young men. Simple interactions can help save lives in the long run.” Kelvin Mgrebe, Babcock Ntuthuko 31
Good for Families The SWHAP programme does not stop only with ensuring benefits for companies and their employees; it also involves itself with the health of their spouses and children. Including families in the programme promotes uptake of testing, treatment, and supplementary nutritional support to affected families leading to greater openess and voluntary disclosure of HIV status. Wellness programme family activities include: l Spousal Peer Education Training where spouses of employees are trained on HIV and AIDS and sexual and reproductive health and rights, enabling them to become behaviour change advocates and community psychosocial counsellors in their families and communities. This reduces the information gap between partners on HIV transmission, progression, prevention and management and increases the acceptability of workplace programmes. It also increases levels of HIV and AIDS information within the wider community; some spouses volunteer at local clinics reaching audiences that extend far beyond the workplace programme. l Spouse Clubs where the mainly female partners of employees receive training in financial literacy, and technical and financial support on income generation opportunities. l Family Wellness Days that intersperse sporting activities and games with HIV messaging, general health and HIV and biometric testing. l Workplace-based activities to promote couples communication, testing and voluntary disclosure of HIV status. l Youth life skills training for children, promoting delayed first sex and responsible sexual behaviour. Educating their parents also improved their communication skills in discussing issues around sex and HIV. l Workplace policies that include benefits for spouses and other family members. l Promoting gender mainstreaming through strategies and approaches that include spouses and communities. Between 2007 and 2017, 28,584 family members 32 participated in the programme
Supporting Testing for Couples Britos’ Story Britos Mapfumo worked with Sandvik Zimbabwe from 1973. He shares how he confronted and survived HIV, speaking passionately about how he fought to return to work and live a normal life with HIV. Today he is a wellness champion in his community. “I was employed as a machine worker for 32 years and found out my HIV status in 2005, after multiple complications. I was retired on grounds of ill-health and Sandvik assisted my spouse to also get tested. My wife and I received treatment and nutritional support from Sandvik for two years while I was on retirement. I have since regained full strength and was certified fit for work and re-engaged in November 2008. My advice to everyone is that they need to know their status and seek early treatment for ART to be effective.” Now aged 64, Britos has finally retired and looks forward to a long and fulfilling retirement. 33
Spousal Peer Education Training Lillian’s Story Lillian Chanda, Chairperson of the Women’s Spousal Group at SKF Zambia, nurse and mother of six, explains why she became a Spouse Peer Educator. “I have always wanted to support colleagues to cope with the different challenges they go through in life. My husband works at SKF, which has a comprehensive wellness programme. I joined their Spousal programme and this was my chance to be a cornerstone of change for myself, my family and my community. This was the beginning of my journey to become nurse-midwife which has provided my family with an additional source of income. The meetings I attend with other spouses offer me additional training and have deepened my understanding. At the clinic, I conduct health sessions in the antenatal department and share the topics we learn as Peer Educators. It is very satisfying to counsel couples on issues around HIV: you chat to a woman who comes alone and the next time she come together with her partner. On a personal level, the information on couples communication has helped in our home. Now we value open communication and we are happier. We communicate easily and my children have also embraced wellness; we take care what we eat and exercise regularly.” 34
Good for Communities Once a workplace is implementing a sustainable workplace wellness management programme it is encouraged to share its experiences through initiatives such as supply chain programme and mentoring. Supporting the Value Chain Sandvik Zimbabwe partnered with SWHAP in 2007 and over the years, has developed a successful in-house as well as community response to HIV and Wellness. In 2010, Sandvik ran their first Supply Chain Programme by mentoring seven companies to develop and strengthen their workplace policies and programmes. The mentorship paid dividends with partners such as Freda Rebecca gold mine, where programmes became more participatory. Prior to Sandvik’s mentorship, HCT uptake at Freda Rebecca was very low and there was a high rate of sick leave due to opportunistic infections; a seroprevalence survey found the mine’s HIV burden to be 13.7%. Achievements: ll Reduction in seroprevalence of 3.1% between 2011 and 2014. ll Approximately 35% reduction in absenteeism due to HIV/ AIDS related illness. ll HCT uptake improved by 50.5% after mentorship process. ll The mine Wellness Centre was also registered as an antiretroviral treatment centre and most employees transferred from the national hospital Opportunistic Infections clinic to the on-site clinic, reducing lost man- hours as employees avoided long queues. ll Freda Rebecca Mine later became a runner-up for the SWHAP Achievement Award for Best Progress in 2016. Today over 80% of employees know their HIV status. 35
“The partnership with Sandvik and SWHAP played a very vital role in improving the Freda Rebecca Gold Mine Wellness standards. This is reflected through increased worker retention, increased access to HIV and AIDS services, reduced absenteeism due to HIV related sickness, increased responsiveness of company management to the needs of HIV positive workers and improved observance of workers’ rights based on gender.” - Sister John, Sister in Charge, Freda Rebecca Gold Mine 36
Community Outreach Initiatives Changing Lives Community outreach encouraged by SWHAP enables companies to reach out to high risk groups such as youth, and develop community- wide positive social behaviours and risk awareness. SWHAP networks across the region engage with local communities and networks of people living with HIV, assisting where they can. The majority of the outreach activities are conducted by Peer Educators who extend the reach of wellness programmes into communities leading to provision of innovative assistance. Naomi’s Story Peer Educators from the Kenya SWHAP network were visiting the Kenya Network of Women Living with HIV/AIDS (KENWA) Children’s Home as part of the annual International AIDS Day celebrations, when they met Naomi Kimani. “I have been HIV positive since birth. My parents passed on when I was very young. When I learnt about my status, I decided that it would not be a limitation for me.” Naomi had been accepted into teacher education college, but had no money to pay fees. The Peer Educators pooled their resources to pay for her first semester fees and Atlas Copco subsequently took over. In June 2017, Naomi graduated with a Diploma in Education and started teaching maths, science and English at a school in Muranga County Kenya. 37
Soon afterwards, she started a support group for young people living with HIV that is having a positive impact on young people whose parents are employed amongst companies in the SWHAP network. “Our activities are mainly mentoring young adolescents who are on care and especially those in boarding schools to ensure they adhere to their medication. We also visit children’s homes to encourage HIV positive youth that there is a future for them.” Naomi is optimistic about her future. “2018 started with a lot of blessings. I was promoted to deputy head teacher, I got married and I am expecting a baby. I am very positive that my baby will be born negative. I started my antenatal care early in the pregnancy and I have adhered to my medication and all the instructions given to me by my doctor. I want to encourage anyone who feels that all is lost when you test positive. Life moves on my friend. It is just a simple condition, which is manageable if you adhere to medication and choose to have a positive outlook. I have been positive since birth but I am now 24 and making it in life with my own family.” Between 2010 and 2017, Peer Educators reached over 84 000 people outside the workforce with information on HIV and wellness 38
Mirelle’s Story Mirelle lives in Katanga and works with the CSC as the Focal Point for HIV and Informal Sector reaching out to informal sector workers. Troubled by the lack of access to healthcare for the people in her community, Mirelle wanted to do more to bridge the gap. “I was struck by how isolated people working in the informal sector are, and how little access they have to health information and services, yet their work and lifestyle often put them at greater risk of ill health or HIV infection. I was really motivated to get involved after attending the SWHAP conference in 2015, and registered a foundation to sensitise people on family planning, marriage counselling, prevention of communicable diseases (HIV, malaria, TB) and diabetes. People in the community did not know about birth spacing or HIV and many women who had been raped were testing positive for TB. Knowing the link between HIV and TB, I wanted to encourage them to get tested for HIV. Through partnerships with other organisations we were able to get access to post- exposure prophylaxis (PEP) for rape survivors and so far, we have distributed PEP to 50 people and provided access to family planning services to 200 people. We have also received support to build a maternity wing. To help address poverty in the community, our services evolved to include vocational training helping people learn skills that would provide better employment or income generating opportunities, while improving their access to healthcare services. We train about 50 people every month and have trained 315 people since 2016.” What motivates you? “I think this is a calling. When I was younger I wanted to be a nun, but my family refused and forced me to get married at a 17 during the time of the rebellion war with Rwanda. I am fortunate to have a great team that runs the foundation allowing me to carry on with my work at CSC.” 39
Companies Supporting Community Life Skills ll Metso South Africa, is implementing a life skills programme including age appropriate information on SRHR for adolescents at an SOS village. ll Sandvik Tanzania has reached 156 boys and 10,000 spectators with information on HIV and healthy lifestyle choices through high volume sports intervention programmes. ll Scania conducted road shows targeted at truck drivers in partnership with SWHAP and other stakeholders, providing information on HIV and AIDS to a hard to reach and high-risk group, and breaching what is considered a taboo subject for many in the sector. ll Shreeji Chemicals, a mentee company of Raffia Bags, Kenya, have mobilised campaigns heightening awareness of gender- based violence in the community, reaching 500 people from 150 households with information on GBV and the importance of HIV testing. ll Atlas Copco has also been enthusiastic in sharing their experiences through enhanced community outreach as in the Atlas Copco Zambia Spouses’ Association in Kitwe. Spouses of employees have been trained as Community Peer Educators and now provide HIV and AIDS information to rural and urban communities. 40
A Huge Thank You! We would like to thank all our partners – workers, unions, companies, other partner organisations and our funder Sida, – for having the vision and courage to join SWHAP and for contributing to its success in the response to HIV, AIDS and Wellness. While HIV continues to have a big impact on the daily lives of many people it is no longer the imminent threat to life and productivity it was 14 years ago. Today we are better equipped to manage HIV as a chronic condition and the social stigma surrounding the virus has improved. The workplace programmes participating in SWHAP are living proof that partnerships based on mutual respect and inclusion are a successful path to engage with the daily and future challenges faced by companies. Workplaces and communities in sub-Saharan Africa are now facing different challenges related to unemployment (especially among the youth), non-communicable and lifestyle diseases, diversity inclusion and gender inequality as well as industrial transformation. We believe that the successes of the last 14 years and SWHAP’s unique values of partnership, catalytic support, and using the workplace as a change agent, will continue to improve health prospects throughout sub-Saharan Africa and assist in finding solutions to any new challenges. SWHAP is now looking to the future and building on our experiences to address common challenges and contribute to positive economic and social development through continued partnership and sustainable workplace programmes. We look forward to continue this joint partnership with you. 41
Together for Wellness
14 The Swedish Workplace HIV and AIDS Programme General Programme Secretariat Address: PO Box 555 45, SE 102 04 Stockholm, SWEDEN Tel: +46 8 783 80 00 E-mail: info@swhap.org Website: www.swhap.org company/swedish-workplace-hiv-and-aids-programme @SwedishWorkplaceHIVandAIDSProgramme @SWHAP_Sweden
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